Inappropriate CNA behavior?

Nurses General Nursing

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Hi, so I just had my first clinical this past Saturday, and the CNA that my partner and I were shadowing had some unsettling behaviors... I've read a few posts that were similar to this one, and a lot of responses were things like "you're new to the nursing industry, so things will differ from your class and the real world" or something similar. I understand this, though this particular scenario seems very unprofessional to me, even when trying to view it through the eyes of an experienced CNA or nurse, so I've decided to seek your input anyways.

When my partner and I first approached the CNA we were going to be shadowing, she already looked very annoyed and in a bad mood. I didn't mind, because I knew I was going to be working with her anyway, but that same attitude was directed at the residents of the nursing home we train in. As we were leaving the first room we had gone into, another CNA came inside and asked the resident if he was ready for breakfast, and he said yes, to which our CNA responded with "Oh, so you'll listen to HER but you won't listen to me?" The resident struggled to talk, but eventually we were able to make out "you need to speak in a friendlier tone." She repeated it, "Oh, speak in a friendlier tone?" then walked straight out. The resident looked mad, then he turned to me and said "One day, they'll learn." That was one of the first warning bells.

Other things that went on that day:

- A resident told me that he needed to use the bathroom, twice, and when I told my CNA, she went into his room and told him to go in his briefs. Both times. He didn't want to, so she made him hold his urine while he ate breakfast, and since he needed assistance with eating... It took a long time. When we came back, he again asked for assistance using the bathroom, and again, she told him to just go in his briefs.

- She CONSTANTLY bad-talked her residents, right outside the door, calling them cranky and rude, etc., talking about some of their bad episodes. I don't know how mentally "there" some of those patients were, but I'm sure some of them heard her. She talked loud enough to where I would've been able to clearly understand what she was saying had I been in the room, and I'm sure there must've been some residents who could have, as well.

- When trying to get a urine sample from one resident, the resident accidentally defecated into the bedpan. Both CNAs were laughing about the whole thing and going "ewwwww" the whole time. They kept commenting on how gross and big it was, how she ruined the sample, and talking about how it stank. The resident was laying right there when all of that was being said. I don't think that resident was "all there", but at the same time, to be talking about her like that right in front of her seemed demeaning. When we first came into the room, she also talked about the resident's crankiness, like scoffing about her bad temper as we were standing 5 inches away from her.

- She went to check in on a resident, who had a bag of chips in his hand, and she suddenly demanded to know whether or not he was done with his chips. It just seemed so abrupt and random, and the resident just kind of stared at her blankly and she angrily asked again, "ARE YOU DONE WITH YOUR CHIPS? YES OR NO."

- She and another CNA rolled their eyes and scoffed whenever a resident didn't want to get up in time for breakfast or lunch, as if it was this huge issue and "how dare they".

The whole day was like this, where she bad-talked residents either right next to them, or out in the hallway where they could still potentially hear her. Her tone, was absolutely terrible. She sounded like an annoyed mother, was very short with her residents, and talked to them like a teenager? She's in her early 20s, I'd say, but her tone of voice and her way of speaking was unprofessional, and at times, seemed downright mean. I mentioned to my instructor in private that it seemed that she might've come off as "rough" to the residents, and I said that I knew some things differed from class and real life, but I wanted to confirm that we weren't supposed to tell residents to "go in their briefs" to which she adamantly explained that no, you never do that.

My instructor said that she wanted to know these things, but I didn't go into detail because I wasn't sure if I was just making a big deal out of something small, and I don't want to be a complainer. The more I think about it, however, the more wrong I think it was. I think talking bad about the resident RIGHT as you are standing next to them, as if they weren't there, is absolutely terrible, even if their mind isn't completely there. They might be anxious or depressed that they were in that situation, and then because of mental deterioration and perhaps hormonal problems, they were lashing out. Nevertheless, it's still demeaning to treat them in that manner.

There were other CNAs that my partner and I tagged along with, and they were the complete opposite. They took their time with the residents, and were kind to them even when they were slow, or cranky. They used a kind and respectful tone, and one of the CNAs even went on telling us how to make sure that our residents looked nice before going down to the cafeteria, "pull down their shirts- make sure their stomach is covered and their clothes are straight. Think about how you would want your parents or grandparents treated in a nursing home." It was such a stark contrast, to where I feel like I can't look at the other CNA and pretend that it was normal or OK to act like that.

Is this something I should talk to my instructor about more? She works at this facility and is in charge of the staff. I don't want to complain or start drama, but I also want to do the right thing. I also have 5 more clinicals there. I also might get a temporary job there as a NAR... Am I being overdramatic? I want to hear your input. Thanks ahead of time.

WOW!!! Always think of it this way...would you want your mother, father, grandmother, or grandfather to be spoken to that way or treated that way??? If the answer is NO, then it probably isn't right for any other resident. And truly should be reported to the abuse coordinator and investigated. I'm sure both of those girls have bowel movements that smell like roses...not! It hurts my heart to hear of residents being done this way! And so what if they are grouchy!! We would be too if someone took us out of our home and put us in some unfamiliar place with people that don't even care about us. Took all our freedom away for some little brats to be rude and unappreciative of our lives. Oh this makes me angry!!!

If you feel it's not right in your heart and wouldn't want your family member being done that way then you can bet your bottom dollar it's probably not right!!!

I've met CNAs like that, they do exist unfortunately. They either leave or get fired. You talked to your instructor about it already, which was the right thing to do. What you described is verbal and emotional abuse.

I don't know what else you can do right now. If I was the instructor I would investigate and that would take a little time. I wouldn't instantly fire someone because another CNA told me what you described. She will probably try to discreetly observe the CNA and talk to the residents. Your instructor might already be aware and might be in the process of trying to hire someone to replace her. This could take some time, not a lot of people apply to be CNAs.

You can encourage residents to talk to the instructor if they have complaints. You might have to reassure them that what they say will be confidential and they won't face retaliation.

I would wait a week and see what happens. Only if you continue to notice further inappropriate behaviors then I would ask to speak with the instructor to follow up on your concern. I doubt it, but that CNA could've just been having a bad day. Think carefully about what you want to say first so you sound like you're advocating for your residents and not tattling on a coworker.

WOW!!!! I have been a nurse for over 30 years and can't tell you how often I have seen this behaviour. Yes management is aware of this. But because of short staffing they are NOT going to do anything about it. It needs to be brought their attention often. You do the right thing always. In everything you do. At the end of the day, uou need to be able to think you did what you could to make someone's day better. Can you imagine being the patient and seeing that this CNA is yours all day? Thank God I am not a family member overhearthis CNA...you just be you, God bless.

If what you are saying is exactly what happened, it's an issue, should be reported and investigated. Period.

Specializes in Psychiatric nursing.

Honestly, it's hard to find good CNAs because they're not paid well--particularly in nursing homes-- and this is the result. When I worked as a CNA in a nursing home, there was a coworker who was caught *kissing* one of the residents! On the mouth! Did he get fired? No! Because he showed up and did a "good job" -- other than the fact that he had a habit of molesting elderly people. One resident in particular used to sun-down really badly: she'd basically scream for hours every evening. My coworker would shut himself in her room with her and she'd go miraculously silent. What the heck was going on in there?? No one asked, because everyone was just relieved this poor woman wasn't screaming--and they felt like they couldn't fire anyone because they were minimally staffed as it was. (I think of this often and wish I'd reported the situation to someone... but I was young and dumb. :( )

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